Clinical Study Of Tranexamic Acid In Reducing Perioperative Blood Loss In Patients With Multilevel Thoracic Spinal Stenosis

Objective: To investigate the effect of intravenous tranexamic acid for reducing perioperative blood loss in patients with multilevel thoracic spinal stenosis.Methods: This is a retrospective observational study of 42 patients with multilevel thoracic spinal stenosis admitted from December 2016 to October 2017 to the spine department of Xi'an Honghui Hospital who underwent posterolateral bone graft fusion with posterior laminectomy and decompression fixation.The patients were divided into two groups,all of whom were completed by a team of doctors with rich clinical experience in the hospital,Group A received an intravenous infusion of 15 mg/kg 15 minutes before surgery,and continued to infuse 1mg/kg/h of TXA until the skin closed.Group B received no TXA as a blank control group.The coagulation function before and 48 hours after operation,the instrumented levels,the laminectomy levels,intraoperative blood loss,blood transfusion volume,drainage volume,extubation time,postoperative hospital stay and postoperative DVT rate in each group were recorded.Results: There was no significant difference between the two groups in general characteristics,such as gender,age and Body Mass Index(BMI)(P > 0.05).Among them,there were 10 males and 10 females in group A,with an average age of(53.41±7.93)years old.Group B patients had 11 males and 11 females with an average age of(55.10±8.43)years old.There was no significant difference between the two groups in the levels are instrumented and the laminectomy levels in each group.The instrumented levels in group A and group B was 170 and 186,respectively.The laminectomy levels in group A and group B was 64 and 69,respectively.There was no significant difference between the two groups in the instrumented and laminectomy segment.(P >0.05).The intraoperative blood loss in group A and group B was(1520.50±419.66 vs 1994.75±434.12)mL,and the mean blood transfusion volume was(963.64±341.63 vs1680.00±442.01)mL,the mean postoperative drainage was(352.14±127.41 vs 438.00±112.14)mL,the mean extubation time were(3.00±1.27 vs 3.85±0.88)days,and average postoperative hospital stay were(4.23±1.02 vs 5.55± 1.28)days,and there was a significant difference between the two groups(P<0.05).All the details shows that in group A were lower than those in group B,and there was a significant difference between the two groups.Although the levels of PT,APTT,INR and D-dimer in group A were slightly higher than those in group B before and after surgery,there was no significant difference between the two groups(P > 0.05).The preoperative and postoperative coagulation in two groups were recorded,and there was no significant difference between two groups.There was no DVT occurred before discharged.Conclusion: In the treatment of multilevel thoracic spinal canal stenosis using trabeculectomy with posterior laminectomy and posterolateral bone graft fusion,TXA can reduce the amount of blood transfused and the need for blood transfusion and the drainage volume and can shorten the extubation time and the length of postoperative hospital stay without increasing the incidence of postoperative coagulation dysfunction or postoperative DVT.